MEDICARE: MED SOUTH, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124185640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED SOUTH, INC

Provider Business Mailing Address
First Line	:	406 MEDICAL CENTER DR
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-3400
Country	:	US
Telephone Number	:	205-221-8200
Fax Number	:	205-221-8270

Provider Business Practice Location Address
First Line	:	4505 HIGHWAY 78 E STE 100
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8882
Country	:	US
Telephone Number	:	205-384-3626
Fax Number	:	205-384-5526

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LISA J WELLS
Credential	:
Telephone Number	:	205-221-8258

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	03/24/2018

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Directions to “MED SOUTH, INC ” Practice Location

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